"I am happy that our president got a perfect score of 30 out of 30 on his cognitive screen, the Montreal Cognitive Assessment, or MoCA, a tool commonly used to identify mild cognitive impairment. Passing this test means less than most people think. At all levels of our society, I find that the popular understanding of decision-making “capacity” is not nearly adequate for the silver tsunami of elders in the pipeline. MoCA, and other tests used to judge capacity, only roughly approximate an elder’s fitness to manage his or her life. These tests often fail to catch the nuances that can mean the difference between an elder getting the care they need rather than being swindled out of their life savings.

Here’s a recent horror story that may make the point: I had a patient with complicated medical issues who had a hip replacement operation. To my dismay, the hospital discharged this man to “assisted living.”

"I’m sorry this is just not the behavior of an experienced politician. It’s also not the behavior of a person whose brain is working normally." When dementia is involved, sexuality can be very complicated.

Financial elder abuse is much more common than most of us wish to think. Some believe that it will be the greatest crime of the 21st Century. This abuse doesn't always come from 'scammers' outside the house or on the phone. Often, sadly, it comes from relatives of the elder. When you add dementia to the mix, it's a terrible problem.